| NPI | 1962607317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AZ 21315) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA G87523) |
| Enumeration Date | 2007-06-17 |
| Last Update Date | 2016-10-03 |